Document 6449542

Transcription

Document 6449542

Teaching
Students
with Fetal
Alcohol
Spectrum
Disorders
AResourceGuideforFloridaEducators
2005
Florida Department of Education
Bureau of Exceptional Education and Student Services
Teaching
Students
with Fetal
Alcohol
Spectrum
Disorders
April 2005
Florida State University Center
for Prevention & Early Intervention Policy
Shawn Baldwin, M.S.
AssistantinResearch
Resource Guide Development
Rita LeBlanc, M.S.
PublicationsCoordinator
Layout & Design
The development of this guide was funded by the Florida Department of Education.
Teaching
Students
with Fetal
Alcohol
Spectrum
Disorders
CONTENTS
Introduction.......................................................... SectionOne
OverviewofFetalAlcoholSpectrumDisorders......... SectionTwo
TheEffectsofAlcoholExposure
ontheDevelopingFetus......................................... 7
SectionThree
RealisticExpectationsofStudentswithFASD.........
SectionFour
ImplicationsforEducators................................... 8
SectionFive
Resources.......................................................... References.......................................................... 8
Introduction
T
he result of prenatal exposure to alcohol ranges from Fetal
Alcohol Syndrome (FAS), the leading cause of preventable
mental retardation in the United States, to other fetal
alcohol effects causing lifelong disruptions in cognitive, linguistic,
and social development. This range of effects is referred to as Fetal
Alcohol Spectrum Disorders (FASD). The most common birth
defect associated with FASD is central nervous dysfunction, and
children prenatally exposed to alcohol may present with cognitive,
behavioral, and psychological dysfunction resulting in lifelong
disabilities. Abnormal cognitive functioning manifests in a variety of
domains, including mathematical deficiency, difficulty with abstract
concepts such as time and space, and inability to see the relationship
between cause and effect, as well as comprehension and memory
deficits. FASD is a physical disability with behavioral symptoms often
demonstrated by poor attention and concentration skills, impaired
judgment, hyperactivity, and impulsivity (Streissguth, 1997; Malbin,
2002).
Families of children with FASD are faced with a multitude of issues
touching every aspect of their lives. In addition to addressing the
immediate physical, educational, and financial needs of their child,
families must also identify long-range strategies to ensure these needs
are met throughout the lifetime of the child. The emotional toll on
families should not be underestimated. For natural birth parents,
the reality that their child’s mental retardation, birth defects, and/
or neurodevelopmental disorders are a result of maternal alcohol
consumption during pregnancy is very difficult to face. For adoptive
or foster parents, discovering that their child suffers from FASD after
years of trying to understand his cognitive and behavioral problems
results in feelings of frustration and isolation (Abel, 1988; Davis &
Lipson 1984).
Childrenwithprenatalexposure
toalcoholmaypresentwith
cognitive,behavioral,and
psychologicaldysfunctionthat
causeslifelongdisabilities.
Abnormalcognitivefunctioning
manifestsinavarietyofdomains,
includingmathematical
deficiency,difficultywithabstract
conceptssuchastimeand
space,andinabilitytoseethe
relationshipbetweencauseand
effect,aswellascomprehension
andmemorydeficits.
WhilechildrenwithFetalAlcohol
SpectrumDisordersmaybe
affectedatalmosteverylevelof
functioning,nowhereisitclearer
thanintheacademicarena.
The effects of prenatal exposure to alcohol have been well
documented in empirical and clinical studies over the last 30 years.
First identified in the United States in the landmark study Patternsof
MalformationsinOffspringofChronicAlcoholicMothers(Jones, Smith,
Ulleland, & Streissguth, 1973), Fetal Alcohol Syndrome and Fetal
Alcohol Spectrum Disorders have been the subject of hundreds of
articles in a diversity of publications from the JournaloftheAmerican
MedicalAssociationtoClinicalLinguisticsandPhonetics. The
inclusion of this subject across such a broad spectrum of publications
is indicative of the range of effects of FASD. The negative effects
of prenatal exposure to alcohol range from mild cognitive and/or
behavioral dysfunction to profound mental retardation. The effects
are lifelong but may be mitigated with early intervention (Streissguth,
7
1996). While children with Fetal Alcohol Spectrum Disorders may
be affected in almost every area of functioning, nowhere is it clearer
than in the academic arena.
MyTh:
Admittingthatchildrenwith
FASDhavebraindamagemeans
thatsocietyhasgivenuponthem.
FACT:
Some people believe that
acknowledging the brain damage
that accompanies FASD will
depict those affected as hopeless
and devoid of treatment options.
Yet, society spends millions of
dollars developing treatment
procedures for children born with
more obvious birth defects and for
people sustaining brain damage
in more noticeable ways (e.g., auto
accidents). Individuals with FASD
are in no way helpless, but their
needs have been sadly overlooked
in the allocation of societal
resources.
Teachers face unique challenges in working with children with
FASD. Many children with FASD are not diagnosed until they reach
elementary school, when higher-level executive functioning skills
are needed. Even then, classroom teachers may not have the tools or
information needed to correctly identify the cause of the cognitive
or behavioral problems, or know of intervention strategies to help
these children reach their full academic potential. Best educational
practices require the development and implementation of academic
and behavioral strategies to address the needs of students with FASD.
Despite the best efforts of general and special educators, parents
often feel school personnel do not understand and, therefore, cannot
address the unique needs of students with FASD.
This resource guide provides important information to assist
educators and school health care professionals in understanding
FASD. SectionOne discusses the problems children with FASD
have, provides an introduction to FASD, and explains the
latest terminology. SectionTwo explains how and when alcohol
consumption affects fetal development, brain development,
and sensory integration. SectionThree discusses the possible
misdiagnosis and/or the co-occurring diagnosis of students with
FASD, the differences in strategies depending on the diagnosis,
and realistic expectations of students with FASD. SectionFour
discusses implications for educators and outlines strategies by age
group. SectionFive contains a comprehensive list of FASD resources
including books, videos, support organizations, newsletters, and
websites.
The information provided in this resource manual is based on the
research and literature currently available. It is our hope that it will
provide intervention strategies that will be used by educators to
promote a positive academic experience and support individuals with
FASD in reaching their full potential.
8
PrimaryPerformanceProblems
AssociatedwithFetalAlcoholSpectrumDisorders
Prenatal alcohol exposure often results in central nervous system dysfunction that affects a student’s
ability to successfully perform in an academic setting. The frequency and magnitude of these
problems varies greatly among affected students and is not correlated to IQ scores.
1.
Compromised executive
functioning; may have difficulty
planning, predicting, organizing,
prioritizing, sequencing, initiating,
and following through. Difficulty
setting goals, complying with
contractual expectations, being on
time, or adhering to a schedule.
8.
Language problems; difficulty
comprehending the meaning of language
and accurately answering questions. May
agree or confabulate, comply or fill in the
blanks. May talk excessively, yet be unable
to engage in a meaningful exchange. The
sheer volume of words may create the
impression of competence.
2.
Difficulty with memory;
information input, integration,
forming associations, retrieval, and
output. Difficulty learning from
past experiences. Often repeats
the same mistake over and over
again in spite of increasingly severe
punishment.
9.
Slow cognitive pace; may think more slowly,
may require minutes to generate an answer
rather than seconds. Students with FASD
are “ten-second people in a one-second
world.”
3.
4.
5.
Inconsistent memory or
performance; may remember on
Monday but forget by Thursday.
6.
Inability to generalize information;
difficulty forming links and
associations, unable to apply a
learned rule in new setting.
7.
Communication challenges; appears
to understand instructions, but
actually does not comprehend.
Often repeats rules verbatim, then
fails to apply them.
Difficulty with abstract concepts
such as time, math, or money.
Impaired judgment; often unable
to make decisions. Difficulty
differentiating safety from danger,
friend from stranger, or fantasy
from reality.
10.
Slow auditory pace; central auditory delays
means language is processed more slowly,
requiring more time to comprehend. Many
students only grasp every third word of
normally paced speech.
11.
Perseveration; may be rigid, get stuck,
have difficulty switching gears, stopping
an activity, or transitioning to a new one.
Often reacts strongly to changes in setting,
program, and/or personnel.
12.
Dysmaturity; often functions socially,
emotionally, and cognitively at a much
younger level of development than
chronological age.
13.
14.
Impulsivity coupled with inability to
abstract and predict outcomes; acts first and
then is able to see the problem after the fact.
Sensory integration dysfunction; May
overreact to stimuli. May display tactile
defensiveness, be easily overwhelmed
by sensory input, be unable to filter out
extraneous stimuli. May underreact to pain.
Adapted from: Diane Malbin, Fetal Alcohol Spectrum Disorder and the Role of Family Court Judges in Improving Outcomes for
Children and Families. JuvenileandFamilyCourtJournal, Spring 2004.
SectionOne
Overview of Fetal Alcohol
Spectrum Disorders
The Vocabulary
MyTh:
Childreneventuallyoutgrow
FASD.
FACT:
FASD lasts a lifetime: although,
its manifestations and associate
complications vary with age.
Children with FASD usually require
a longer period of sheltered living,
and many need a stronger than
usual support system to achieve
their optimal level of adaptive
living. Understanding this can
help families plan effectively for
structured transitions between
school and work and spare their
child the expectation that they
should or must be independent at
age 18, or that it is shameful to ask
for help.
Over the last several years the vocabulary used to describe individuals
prenatally exposed to alcohol has evolved. First identified in the
United States in 1973 (Jones, Smith, Ulleland, & Streissguth, 1973),
FAS is characterized by specific diagnostic criteria. Beginning
in 1978, the term Fetal Alcohol Effects (FAE) has been used to
describe conditions that are presumed to be caused by prenatal
alcohol exposure but do not follow the exact configuration of the
characteristics that uniquely identify FAS. In 1996, the Institute of
Medicine proposed using the terms Partial Fetal Alcohol Syndrome
(PFAS) to describe those individuals with some but not all of the
facial abnormalities that characterize FAS, and using Alcohol Related
NeurodevelopmentalDisorder(ARND)and Alcohol Related Birth
Defects (ARBD) to describe conditions in which there is a history of
maternal alcohol exposure and an outcome validated by clinical or
animal research to be associated with that exposure (Stratton, Howe,
& Battaglia, 1996). Most recently, the term Fetal Alcohol Spectrum
Disorders (FASD) has emerged to describe the spectrum or range of
clinical conditions associated with prenatal alcohol exposure. FASD
is an umbrella term that includes FAS and other effects of prenatal
alcohol exposure. For the purposes of this resource manual FAS, FAE,
PFAS, ARND, ARBD, and FASD will be used as they appear in the
research supporting the information presented.
Fetal Alcohol Syndrome
Fetal Alcohol Syndrome is a constellation of physical, cognitive, and
behavioral abnormalities resulting from prenatal exposure to alcohol
(Jones, Smith, Ulleland, & Streissguth, 1973). There is general
agreement across the literature that there are four specific criteria
required for a diagnosis of FAS:
n confirmed
n growth
maternal alcohol consumption during the pregnancy;
deficiency, pre or postnatally, for height, weight, or both;
n specific
pattern of anomalies including a face characterized by short
palpebral fissures (eye slits), flat midface, flattened philtrum, and
thin upper lip;
n central
nervous system (CNS) abnormalities. The estimated
prevalence of FAS is one to three births per 1000 (Sampson,
Streissguth, Bookstein, Little, Clarren, Dehaene, Hanson, Graham,
1997).
0
Physical and Neurodevelopmental Characteristics
Children with FAS possess certain common characteristics, as well
as a variety of effects that affect each child differently. However, all
children with FAS possess facial abnormalities that are most easily
recognizable between the ages of 2 through 10 and central nervous
system dysfunction, and many display growth retardation that
manifests itself in below average height throughout their lifetime
and below average weight until adolescence. The illustration below
identifies the facial features characteristic of children with FAS.
from National Institutes of Health Publication No. 99-4368
Fig.FacialFeaturesAssociatedwithFAS
Facial features characteristic of FAS include short palpebral fissures
(eye slits); thin upper lip; shortened upturned nose; flattened,
smooth, wide philtrum; epicanthal folds; and flat midface.
Growth retardation associated with children with FAS includes low
birth weight for gestational age, decelerating weight not caused by
poor nutrition, and a disproportionately low weight to height ratio.
CNS neurodevelopmental abnormalities associated with FAS
include decreased cranial size at birth, structural brain abnormalities,
impaired fine motor skills, neurosensory hearing loss, poor tandem
gait, and poor eye-hand coordination.
Brain damage associated with FAS may include poor habituation,
poor self-regulation, impulsivity, attention deficits, slow central
nervous system processing speed, arithmetic disability, poor capacity
MyTh:
PeoplewithFASDalwayshave
mentalretardation.
FACT:
Although it is true that FASD is
caused by prenatal brain damage
and every person with FASD has
specific, individualized cognitive
strengths and weaknesses, not
all people with FASD have mental
retardation. For example as one
study found, only 25% of 178
individuals with FAS were classified
as having mental retardation
(Streissguth, A., Barr, H., Kogan,
J., & Bookstein, F., 1996). In fact,
it is possible for an individual with
FASD to have an IQ score within the
normal range. FASD diagnostic
centers such as the one at the
University of Washington Medical
School see individuals with a broad
spectrum of IQ scores (Clarren &
Astley, 1997).
for abstraction or metacognition, deficits in higher level receptive
and expressive language, poor impulse control, memory problems,
disorientation in time and space, poor judgment, and difficulty
with self-reflection. Children with FAS who have IQ scores in the
normal range may still have specific cognitive or neuropsychological
impairments or problems with adaptive behaviors that are not
reflected on IQ tests scores.
Birth defects associated with FAS may include cardiac, skeletal, renal,
ocular, and auditory dysfunction.
Fetal Alcohol Spectrum Disorders
Without FAS Characteristics
Unfortunately, absent the physical characteristics associated with FAS,
there are no biochemical tests or physical markers to determine if a
child has FASD. Symptoms may be unrecognizable at birth and may
be misdiagnosed as difficulties resulting from a difficult delivery or
other prenatal stressor. Further, the characteristics of children with
FASD can vary. Often children with alcohol-related, organicallybased brain problems are never given a diagnosis of FASD. The
cognitive, behavioral, and language manifestations of alcohol’s effects
are often attributed to disabilities such as attention deficit or general
developmental delays.
While FASD may not always include the full battery of physical
symptoms seen in children with FAS, neither is it considered a less
severe form of FAS. To the contrary, since they lack outward signs
and consequently are not perceived as having brain damage, children
affected by FASD without the FAS characteristics often have more
problematic experiences in school and as adults (Streisguth 1997).
Most easily recognizable, the physical characteristics of FASD (growth
deficiencies and facial features) are not really its essence. The real
long-term disability of FASD is the CNS dysfunction.
IndicationsofpossibleCNSabnormalitiesinclude
n head circumference below the third percentile
n developmental delays
n poor impulse control
n inconsistent knowledge base
n difficulty grasping abstract concepts
n speech/language disorders
n problems with perception, sensory integration, and tactile
defensiveness
n hyperactivity
n learning disabilities
n distractibility.
The Effects of Alcohol
Exposure on the
Developing Fetus
SectionTwo
The placenta does not protect the developing fetus from the negative
effects of alcohol exposure. Ethanol (the kind of alcohol in beverages)
crosses the placenta freely. When a pregnant woman consumes
alcohol, her blood levels and those of her fetus are approximately
equal within minutes of consumption (Streissguth & Little, 1994).
The developing fetus is negatively affected by alcohol exposure
in a variety of ways. The table below indicates which areas of the
developing fetus are affected during different stages of the gestation
period.
Fig.AreasofDevelopingFetusAffectedDuringPregnancy
Fig.byPrenatalAlcoholExposure
2 Areas of Developing Fetus Affected During Pregnancy by
Prenatal Alcohol Exposure
G E S TAT I O N P E R I O D I N W E E K S
7
0 6
8 7
AFFECTED AREAS
Brain
heart
Arms
Eyes
Legs
Teeth
Palate
Ears
GenitalArea
The Effect of Prenatal Exposure to Alcohol
on Brain Development
As a fetus develops, cells destined to become the brain and nervous
system attach to each other with the help of cell adhesion molecules.
A recent laboratory study by Wilkemeyer, Menkari, Spong, and
Charness (2002) revealed that ethanol interferes with adhesion
molecules and hinders crucial cell-to-cell attachments. Prenatal
alcohol exposure can disrupt the normal proliferation and migration
of brain cells and produce structural deviations in brain development.
Prenatal alcohol exposure can also disrupt the electrophysiology
and neurochemical balance of the brain so that messages are not
transmitted as efficiently or as accurately as they should be. In some
children with FASD, the wiring of the brain’s message system is
dysfunctional, causing message receptors to be faulty.
During pregnancy, transient ethanol
exposure can delete millions of neurons from
the developing brain. Consequently, the
primary birth defect associated with prenatal
alcohol exposure is central nervous system
dysfunctioncausing learning disabilities,
behavior problems, memory deficits,
attention deficit hyperactive disorder, and/or
mental retardation. Fetal Alcohol Syndrome
is the leading cause of preventable mental
retardation in the U.S.
Initially, information on the neuroanatomical effects of prenatal
alcohol exposure came from autopsies of children with FAS (Clarren,
1986; Mattson, & Riley, 1996). The photo below (Fig. 3) compares
the brain on the left of a 5-day-old infant with FAS and the brain on
the right of a 5-day-old infant with normal brain development.
Theseautopsiesrevealed
n malformations of the brain tissue
n failure of certain brain regions to develop at all
n failure of certain cells to migrate to their appropriate locations
during embryonic brain development n a tendency for the tissue to die off in other brain regions.
Clarren 1986
Fig.ComparisonofBrainofInfantPrenatallyExposedtoAlcohol(left)
andNormalInfantBrain(right)
Using magnetic resonance imaging (MRI) and computed
tomography, which measure the area or volume of a body structure,
researchers have documented the following effects of prenatal
exposure to alcohol on brain development:
n reduced
overall brain size (Mattson et al., 1994, 1996)
n anatomical defects at the midline of the brain, including the
agenesis or underdevelopment of the corpus callosum
(Johnson et al., 1996, Mattson et al., 1994; Riley et al., 1995)
n reduced volume of the cerebellum (Clarren, 1986; Mattson &
Riley, 1996)
n reduced volume of the basal ganglia (Mattson et al., 1994).
Fig.RegionsoftheBrainMostAffectedByPrenatalAlcoholExposure
Region of the Brain
Function
Corpus Callosum
Processes information between the left
and right hemispheres of the brain
Cerebellum
Motor control
Basal Ganglia
Processes memory
Hippocampus
Learning and memory
Frontal Lobes
Impulse control
Theeffectsofprenatalalcoholexposureonbraindevelopmentareeloquently
articulatedbyDr.IraChasnoffoftheChildren’sResearchTriangle.
“T
he behavioral, emotional, and learning difficulties of children with Fetal
Alcohol Syndrome can best be understood as a deficit in processing
information: recording information (bringing it in to the brain), interpreting
the information, storing the information in memory for later use, and using
the information to guide language and movement.
The damage to the brain caused by prenatal alcohol exposure mainly occurs
in the parts of the brain that affect information processing. The hippocampus
connects sensory and motor information from different parts of the brain.
Damage to the hippocampus interferes with the child’s using sensory
information (such as hearing) and connecting that information to a motor
activity. This causes learning and memory problems. For example, asking a
child to take a note to the teacher often will result in her taking the note to
school, but she cannot remember what to do with it when she gets there.
Other alcohol-induced structural changes in the brain can occur in the corpus
callosum, the section of the brain that permits the two major halves of the
brain to share information. If this communication is interrupted, as it is in
alcohol-exposed children, then some types of information can never reach
consciousness. For example, a child can recite the rules for good behavior in
the school lunchroom, but then cannot understand or follow them.
Finally, the thalamus receives input from all over the body and sends it to the
cerebral cortex, the area of the brain responsible for cognition and learning.
The thalamus helps organize behavior related to survival–fighting, feeding, and
fleeing. This is why children with FAS often get a look of panic in their eyes
when faced with a sudden change or threat or when they are overloaded with
information. Parents describe the children as ‘not there.’ Also, the child does
not learn from experience. Parents describe the child as “stubborn,” but the
connections between past instructions or experience and current behavior just
don’t exist.
It therefore can be seen that the behaviors demonstrated by children with FAS
are a result of brain damage, not willful misconduct. When a child knows
all his spelling words one day, and cannot spell a single word the next day,
he often is accused of having “selective memory.” Instead, the child is having
difficulty recording information and storing it for later use. This child will
need special, often multi-sensory, cues to be able to remember the spelling
words. The child who runs out into the street is not being disobedient. She
simply has not made the connection between the words, ‘Do not run out into
the street,’ and the literal motor action. Thus, she will need clear structure
(‘This is the boundary of our yard.’) to ensure her safety.
”
(with permission, Chasnoff, www.childstudy.org)
6
The Effects of Prenatal Exposure to Alcohol
on Executive Functioning
Prenatal exposure to alcohol results in the developing brain being
exposed to a behavioral teratogen that results in behavioral and
cognitive dysfunction even in children without the physical
characteristics associated with FAS. The emerging consensus is
that children with FASD are markedly impaired in “executive
functioning.” These children are less able to work through complex
tasks to achieve a goal. Even children with FAS who perform in the
normal range on simple tests may do poorly in tests assessing complex
cognitive efforts (Mattson et al., 1999).
Fig.Tableofexecutivefunctions
Prenatal exposure to alcohol can affect executive functioning, which is
controlled by the frontal lobes in the following manner:
Executive Functions
Effects of prenatal exposure to alcohol
Inhibitions
Socially inappropriate behavior, as if inebriated
Planning
Inability to apply consequences from past actions
Time Perception
Difficulty with abstract concepts of time and money
Internal Ordering
Difficulty with sequencing, difficulty processing information
Working Memory
Difficulty storing and/or retrieving information
Self-Monitoring
Requires frequent cues, assistance from others with monitoring behavior
Verbal Self-regulation
Needs self-talk, verbal self-feedback
Motor Control
Fine motor skills more affected than gross motor skills
Regulation of Emotion
Difficulty in maintaining stable emotional state, swings from emotional
highs to lows; unable to regain composure without assistance
Motivation
Requires external motivators, may demonstrate lack of remorse
7
Tests of executive functioning assess the ability of students to perform
complex tasks requiring significant cognitive effort, such as planning,
problem solving, judgment, time perception, controlling inhibitions,
self-monitoring, reasoning, internal ordering, arithmetic tasks, and
working memory. A recent study of children prenatally exposed
to alcohol demonstrated various deficits on measures of executive
functioning. For example, on the tower measure shown below, the
only two rules were never place a larger piece on top of a smaller one
and move only one piece at a time. Children with FAS and FAE made
more rule violations than the control group (Mattson et al., 1999).
Fig.6TestofExecutiveFunctioning
The Effect of Prenatal Exposure to Alcohol
on Sensory Integration
Many children with FASD have sensory integration problems
(Schwab, 1999). Sensory integration involves taking in information
from all of our senses, organizing that information, and using it to
respond in an appropriate manner. This process involves the central
nervous system, which is comprised of the brain and the spinal cord.
Students with FASD are likely to have disordered sensory integration
(Schwab, 1999).
The two following illustrations depict normal sensory integration
and disordered sensory integration. It is easy to understand why
students with FASD have problems with concentration, organization,
academic learning, abstract reasoning, and specialization of each side
8
of the body and the brain when their ability to filter and organize
stimulation from their senses is impeded. Strategies designed to limit
and control stimulation have been found to be effective in assisting
students with disordered sensory integration.
Fig.7NormalSensoryIntegration
“Processing touch information correctly allows us to feel safe
and enables us to bond with those who love or care for us.”
Source: Dorothy Schwab
Fig.8DisorderedSensoryIntegration
MyTh:
Thebehaviorproblemsassociated
withFASDaretheresultofpoor
parentingorbadenvironment.
FACT:
Because people with FASD are
born with some brain damage,
they do not process information in
the same way as most people and
do not always behave in a manner
that others expect. Even in the best
environments, the brain damage
can result in behavioral problems
and present parenting challenges.
Parents and caregivers need help
and support, not criticism. Of
course, a loving and understanding
home environment helps a child
with FASD, but its absence isn’t the
primary cause of the behavioral
problems associated with the
disorder.
“Many children with FASD have difficulty processing, organizing,
and coping with the sensory information that constantly bombards
their systems.”
Source: Dorothy Schwab
Realistic Expectations of
Students with FASD
SectionThree
Common Co-occurring/Misdiagnoses of FASD
Many children with FASD have co-occurring disorders or are
misdiagnosed with a disorder other than FASD.
The following list identifies the most common.
n Attention
Deficit Disorder
n Attention
Deficit with Hyperactivity Disorder
n Oppositional
Defiant Disorder
n Reactive
Attachment Disorder
n Learning
Disability
n Speech
and Language Delay
n Pervasive
Developmental Delay
n Developmental
n Sensory
Integration Dysfunction
n Conduct
Disordered, Severely Emotionally Disturbed
n Borderline
Personality Disorder
n Antisocial
Personality Disorder
n Autism,
Receptive Language Disorder
Asberger’s
The strategies needed to address negative behaviors in children with FASD are often very
different from strategies found to be effective for other disorders. The following tables illustrate
the differences in strategies to address basically the same behavior. It is not enough to observe the
behavior; identifying the root cause of the behavior will dictate the most effective intervention
strategy.
Takes risks
Core Cause of Behavior
Intervention
Fetal Alcohol Spectrum
Disorders
n Does not perceive danger
Provide mentor; utilize
a lot of repeated role
playing
Attention Deficit
Hyperactivity Disorder
n Acts impulsively
Utilize behavioral
approaches (e.g., stop
and count to 10)
Oppositional Defiant
Disorder
n Pushes the envelope;
feels omnipotent
Psychotherapy to address
issues; protect from harm
Does not
complete tasks
Intervention
Disorders
n May or may not take in information
n Cannot recall information when
needed
n Cannot remember what to do
Provide one direction at
a time
Attention Deficit with
n Takes in information
n Can recall information when needed
n Gets distracted
Limit stimuli and provide
cues
Disorder
n Takes in information
n Can recall information when needed
n Choose not to do what they are told
Provide positive sense
of control; limits and
consequences
Intervention
Disorders
n Someone told them to
n Misinterprets intentions of others
n May sense bump as attack
n May respond from history of abuse
Deal with
misinterpretations at the
time; one-to-one support
Attention Deficit
n Frequently an impulsive act
Behavioral approaches to
address impulsivity
Disorder
n Plans to hurt others
n Misinterprets intentions of others as
attack or impending attack
Consequences; cognitive
behavioral approaches
Behavior:
Behavior:
Behavior:
Hits others
Source: Dan Dubovsky, SAMHSA FASD Center for Excellence
Revisiting Expectations for Students with FASD
There are four specific criteria related to the diagnosis of FAS:
n confirmed maternal alcohol consumption during the pregnancy;
n growth deficiency, pre or postnatally, for height, or weight, or both;
n specific pattern of anomalies including a characteristic face with
short palpebral fissures (eye slits), flat midface, flattened philtrum
thin upper lip; .
n CNS abnormalities
Equally serious are the invisible symptoms of FASD, neurological
damage including mental retardation; attention and memory deficits;
hyperactivity, difficulty with abstract concepts such as space, time,
or money; poor problem solving skills; difficulty learning from
consequences; poor judgment; immature behavior; and poor impulse
control.
Absent the diagnostic criteria found in children with FAS, children
with FASD often remain undiagnosed. Expectations for these
children are often the same as those for children not affected.
Revisiting our expectations for children with FASD to recognize and
acknowledge that they have neurological brain damage, a physical
disability with behavioral symptoms, provides us with an opportunity
to shift our paradigm and embrace strategies that will work.
Children with Fetal Alcohol Spectrum Disorders often feel bad about
themselves. They have heard their parents, teachers, and counselors
describe them as “stubborn,” “defiant,” and “not motivated,” when
in fact they are overwhelmed with the sights, sounds, smells, textures,
and information bombarding them from all directions. Once parents
and teachers understand the brain-based difficulties in information
processing that confront the child and learn to look beyond the
behaviors they see, they can help the child to make sense of the world
around him.
“P
arents and professionals report a significant shift in their perceptions about
people with FASD once their disability is understood from a neurological
perspective. As a result, feelings toward those with FASD also change, moving from
frustration to understanding and acceptance.
”
The following pre- and post-evaluation of participants in a course at the University
of Wisconsin captures this shift. The column on the left contains descriptions
of children with FASD prior to information on FASD; the column on the right
contains descriptions six months later, after information on FASD was provided.
From seeing the child as…
To understanding the child as…
Won’t ...........................................
Annoying ......................................
Lazy, unmotivated .........................
Lies .............................................
Fussy ...........................................
Acting younger, babied ..................
Trying to get attention ...................
Inappropriate ................................
Refuses to sit still ........................
Resisting .....................................
Can’t
Frustrated, challenged
Tries hard, tired of failing
Fills in the blanks
Oversensitive
Being younger
Needs contact, support
Displays behaviors of younger child
Over-stimulated
Doesn’t get it Personal feelings of the adult
change from…
To feelings of…
Hopelessness ..............................
Fear .............................................
Chaos, confusion ..........................
Power struggles ............................
Isolation ......................................
Hope
Understanding
Organization, comprehension
Working with
Networking, collaboration
Professional shifts from…
To…
Stopping behaviors ....................... Preventing problems
Behavior modification .................... Modeling, using visual cues
Changing people ........................... Changing environments
— Diane Malbin (2002). Tryingdifferently,ratherthanharder(p 42-43).
Implications for Educators
SectionFour
The Range of Educational Responses
Florida’s public schools offer a variety of educational venues in
response to a widely diversified population. Within the public
school construct, students with FASD may be assigned to an
exceptional student education classroom, a regular classroom with
accommodations pursuant to Section 504 (of the Rehabilitation Act
of 1973), or a regular classroom with no accommodation. Regardless
of the setting, an education plan should be developed to ensure that
the student with FASD receives the optimal academic experience and
opportunity. Each student with FASD is different; each educational
response will be different as well. This resource manual is designed
to offer a vast number of alternative strategies to assist teachers’
efforts to respond to the challenges inherent in working with students
with FASD. It should be used in conjunction with other resources
including the practice wisdom of the students themselves, their
families, and the other members of the multidisciplinary team.
Implications for Educators / Strategies That Work
Now that we know what FASD is and how it affects brain
development, sensory integration, learning, cognition, behavior,
and social-emotional development, it is time to explore strategies
that will result in optimal outcomes for a student with FASD.
The intervention strategies identified in this resource guide
are a compilation of research, practice wisdom and vignettes.
Contributing to this body of knowledge are Julie Conry, British
Columbia Department of Education; Jan Osborne, Northwest
Regional Educational Laboratory; Judith Kleinfeld and Siobhan
Wescott, editors of FantasticAntoneSucceeds; Diane Malbin,
author of FetalAlcoholSpectrumDisorders:TryingDifferentlyRather
ThanHarderandFetalAlcoholSyndrome, and FetalAlcoholEffects:
Strategies for Professionals; G. Findlay and A. Sorenson, authors
of WhatEducatorsNeedtoKnowaboutHavingStudentswithFetal
AlcoholSyndromeandFetalAlcoholEffectsintheClassroom:Issues,
Identification,InterventionandInstructionalStrategies; and R.
Schenck, J.T Cole, and C. Medina, authors of FetalAlcoholSyndrome,
FetalAlcoholEffects:ImplicationsforRuralClassrooms. The strategies
are organized in sections by grade level.
Foreachgradelevel—preschool,elementary,middle,andhigh
school—strategiesareorganizedintothreecategories:
.ClassroomEnvironment
Create quite zones.
Design classroom seating.
Limit distractions.
Organize materials.
Establish clear rules for classrooms and learning centers.
.ActiveLearningStrategies
Use multiple modalities, multi-sensory, and/or manipulatives.
Keep steps simple.
Create opportunities for decision making and problem solving.
Model and demonstrate appropriate behaviors.
Provide structure.
.EstablishingRoutines
Maintain a daily schedule.
Ensure consistency in scheduling.
Plan for change.
Build in transitions.
Use visual, auditory, and sensory cues.
ClassroomEnvironment
The classroom setting should be well-organized and designed or
redesigned to accommodate the student’s need for reduced stimuli, a
physical outlet when seated, and visual boundaries. Reduced stimuli
can be achieved by providing head phones with no music or sound;
by designating a quiet area filled with blankets and pillows, or a pup
tent in the corner of the room; or by creating a quiet place where
students can experience a physical release and a degree of solitude.
Allowing students to hold “kushy balls” or other small items that can
be manipulated by hand will provide a physical outlet and increase
the amount of time the student can remain seated. A classroom that
is well-organized and labeled with words and pictures provides a level
of comfort for a student with FASD. Using masking tape to clearly
mark or identify borders provides a visual reminder of where the
student may move about without disturbing the rest of the class.
6
ActiveLearningStrategies
Children with FASD learn differently from other children and often
at a slower pace (Streissguth, 1996). Recognize those differences
and employ strategies that play to the student’s strengths and
accommodate deficits. A carefully orchestrated role play can provide
a positive venue for learning social skills and appropriate behavior.
Building movement into a lesson plan, such as counting the number
of times a student can jump rope in two minutes and then asking the
class to calculate the number of times the student would jump rope
in three minutes or one minute, ties together math and movement
into one activity. Charting the number of jumps for each child adds
another skill.
Students with FASD may have trouble making connections between
experiences. Brainstorming with the students about the similarities
and differences between objects, playing 20 questions, practicing
games that use daily living skills, and comparing what to do in
various situations will help build linkages with experiences.
For students with strength in spatial intelligence, where knowledge
is processed visually through images, pictures, and color, building a
story board for a chapter of text can help with understanding and
comprehending the story. Puppetry is an excellent tool for teaching
concepts, especially social skills. Puppets can be used to model
appropriate behavior while teaching new concepts.
Many students with FASD struggle with social skills throughout their
lifetime. Peer programs that use same-age or older students to assist
in maintaining order can provide opportunities for peer assistants to
model appropriate behaviors and demonstrate positive social skills.
For older students, a peer assistant can take notes for the student
during a lecture and facilitate a discussion to reinforce learning.
EstablishingRoutines
Students with FASD require advance notice of changes and
transitions. Jan Osborne (1994) writes in ASourceBookofSuccessful
School-basedStrategiesforFetalAlcoholandDrugAffectedStudents,
“Try to imagine the affected child as a train. A train cannot make
turns or transitions without the use of a wide or gradual turn;
otherwise, the train jumps the track and crashes.” Accommodating
the need for transition time can be accomplished through a variety of
strategies. Schedules should be posted in the classroom in an ageappropriate manner. For young students with FASD, schedules may
need to be illustrated with large pictures that demonstrate the activity
and corresponding time period. For students at the middle and high
school level, posting the daily schedule in a photo album, on index
cards, or in a book with pictorial cues can provide the same effect.
7
MyTh:
PeoplewithFASDareunmotivated
anduncaring,alwaysmissing
appointmentsoractinginways
thatsocietyconsidersirresponsible
orinappropriate.
FACT:
People with FASD usually care
tremendously about pleasing
others and want desperately
to be accepted, but their basic
organic problems with memory,
distractibility, processing
information, and being
overwhelmed by stimulation
all work against their desires.
They simply have difficulty
understanding the meaning and
interrelationships of a complex
world. In addition, the repeated
experience of failing to meet
expectations can generate a
general reluctance to take on
challenges, even in someone with
the best intentions.
Adapted from Ann Streissguth, Ph. D.,
FetalAlcoholSyndrome:AGuideforFamilies
andCommunities.
8
In addition to establishing a schedule, building transition cues into
the daily routine of younger students such as music, songs, or poems
can relieve the anxiety associated with change. For example, as an
activity nears completion (five minutes prior to the end), begin
playing music or singing a song. This will give the student notice
that the activity is nearing completion. Next, begin a poem or chant
that signals that everyone is to gather in a prearranged place. Finally,
displaying a picture of the next activity gives the student notice of
what is to come next. For upper classes, list scheduled transitions on
color-coded cards with class changes and a map to each class.
Using the strategies outlined on the following pages to design
classrooms that address the student’s needs, to build transition cues
into the daily routine, and to address the different learning processes
of children with FASD will help teachers ensure that the academic
experience is positive and fruitful.
Interventions for Preschoolers
“Teachers must be aware that the type of brain damage that children
with FAS/FAE have often leaves them unable to repeat a skill they
once did with ease” (Harwood & Kleinfeld, 2002).
Preschoolers with FASD may not immediately grasp the meaning of a
word or phrase they just heard. While they may appear to be listening,
they may understand only a fraction of what is said to them (Malbin
1993). Teachers can employ the following strategies to ensure that
preschoolers with FASD gain the most from a learning environment.
1. Classroom Environment
Creating Quiet Zones
Use calm colors on the walls.
n Provide clay or Kushi balls to release hand stress.
n Provide a child sized rocking chair for the child who needs to release energy.
n Provide bean bag chairs for relaxation.
n Create a cocoon with blankets, pillows, and other soft materials.
n Provide head phones with no music or sound.
n Use stuffed animals for comfort and support.
n
Designing Classroom Seating
n
Have students sit on carpet squares for boundaries during circle time.
Limiting Distractions
Limit number and type of objects hanging from ceiling or walls.
n Allow students to stand or move around when working, if possible.
n Avoid loud noises.
n Keep bulletin board decorations to minimum.
n Create a safe area where student can go to work alone without distraction.
n
Organizing Materials
Ensure supplies are well-labeled.
n Use pictures for labels when appropriate.
n Keep areas neat and clean.
n Provide cubbies for individual storage.
n If a teacher’s desk is used, frame it with colored tape to provide a focal point.
n
Interventions for
Preschoolers
Establishing Clear Rules for Classrooms and Learning Centers
Establish classroom procedures/routines and reinforce often.
n Be consistent.
n Provide locks and/or gates for safety.
n Define appropriate behaviors in each setting.
n Post rules in classroom – use pictures and words.
n
2. Active Learning Strategies
Using Multiple Modalities, Multi-sensory, and/or Manipulatives
Provide a Kushi ball to squeeze.
n Have some tactile objects in the classroom.
n Bounce a ball to count.
n Develop building projects.
n Use concrete objects for reinforcing behaviors.
n Draw or role play stories.
n Teach themes.
n Use art activities for learning.
n Use feelings cards.
n Use hands-on manipulative activities.
n Use multi-sensory methods of presentation.
n Appeal to multiple intelligences.
n Employ use of all senses and modes of communication.
n Touch and count objects.
n Use books with simple, plain pictures.
n Read aloud to children.
n Use sensory stimulation to teach concepts; to teach the color orange, wear orange clothes, paint with orange paint, and use
orange paper.
n
0
Keeping Steps Simple
Have students repeat requests or directions.
n Model the expected behavior. n Have students act out the request or directions.
n Be prepared to repeat directions or requests.
n Don’t confuse inability to repeat a skill with unwillingness.
n Be aware of the student’s self-esteem; be willing to reteach and redirect.
n Draw pictures of each step in a sequenced activity.
n Create sequencing games, rhymes, stories, cartoons.
n Repeat, repeat, repeat.
Interventions for
Preschoolers
n
Creating Opportunities for Decision Making and
Problem Solving
Role play ways to handle conflict.
n Involve student in setting goals and planning.
n Discuss what works/what doesn’t work.
n Provide opportunities to practice decision making.
n
Modeling and Demonstrating Appropriate Behaviors
Use peers to help students learn routines.
n Provide opportunities to practice behaviors.
n Role play situations such as fire drills.
n Role play social situations and appropriate behaviors.
n
Providing Structure
Be consistent in routines.
n Announce time limits.
n Use cues to signal the end of an activity.
n
Interventions for
Preschoolers
3. Establishing Routines
Maintaining a Daily Schedule
Alternate quiet time and activities that burn energy every 20
minutes or so.
n Create a calendar for each week; use pictures.
n Create a schedule for each day; use pictures.
n Cross off events/activities when completed.
n Prepare student if you will be gone for a day or more.
n Use rituals for opening and closing each day.
n Review daily schedule each morning.
n Post schedules using words and pictures.
n Provide a consistent schedule.
n
Planning for Change
Prepare student for a substitute teacher when possible.
n Prepare student for new staff, such as teacher aides or volunteers.
n Use a buddy to help with transitions.
n Prepare student for schedule or transition changes by previewing transitions.
n Use transitional cues.
n
Building in Transitions
Build in closure time–count down, 5 minutes, 4 minutes, etc.
n Have next activity ready. n Use music to cue change to next activity.
n Use a motor activity to transition, such as follow the leader.
n Use changes in pace (quiet time, motor activity, short activity, longer activity).
n Provide extra help during transitions.
n Use the same musical theme to signal the end of activities.
n
Using Visual, Auditory, and Sensory Cues
Label with words and/or pictures.
n Use visual cues such as a picture of a clock.
n Use auditory cues such as a pleasant bell tone.
n Say student’s name before question/request.
n
Interventions for Elementary School
Students
Elementary school children with FASD may display attention
impairments, learning disabilities, arithmetic disabilities, specific
cognitive disabilities, deficits in higher order receptive and expressive
language, or poor muscle control. There are, however, strategies
that teachers and caregivers can employ to help facilitate academic
achievement for elementary school children with FASD.
n Create
an emotionally and physically safe environment.
n Create a comfort zone, personal working space, and quiet place.
n Establish “your own space” for student.
n Permit the student to go to comfort zone upon request.
n Allow student to use headphones to listen to soothing music. n Allow student to wear headphones with no music or sound.
n Provide options for movement within boundaries.
n Tape off an area where the student is permitted to move about freely.
n Use pets to practice gentleness and control.
n Allow students to bring stuffed animals for comfort and support.
n Permit worry stones on desks.
n Permit students to have Kushi balls in their hands.
n Use calm colors on the walls.
n Have a child-sized rocking chair in the classroom.
n Have an aquarium with slow moving fish to create calm area.
n Maintain a calm and quiet environment.
n Limit the number and type of objects hanging from the ceiling or
walls.
Kevinandthemathquiz
Kevin,athirdgradeboywithFAS,
completedhismultiplicationfactswith
100percentaccuracyonMondayand
receivedlotsofpraisefromtheteacher
andhispeers.Twodayslater,ona
new,butsimilar,assignment,Kevin
missedalmosthalfofthefacts.His
teacher,familiarwiththelearning
differencesofstudentswithFAS,knows
thatspottyorintermittentlearningand
retrievalisnormal.Shewasableto
reassureKevinhewasokayandbegan
theprocessofreteaching.Kevinlikes
histeacher,feelssafeinsuchastress-free
environment,andcontinuestolook
forwardtocomingtoschool.
n Arrange
desks so students are not facing each other.
n Take health issues into consideration (e.g., hearing, sight, mobility)
and seat accordingly.
n Try using tables rather than desks.
Interventions for
Elementary School
Students
n Limit
the number and type of decorations.
n Decrease the amount of visual and auditory stimulation.
n Permit student to wear earphones without music or sound.
n Allow student time to release energy, and then teach.
n Minimize interruptions.
n Use soothing colors on walls.
n Place posters at sides and back of room to reduce visual distractions.
Organizing Materials
n Ensure
adequate storage space to reduce clutter.
n Use labels, pictures, and words.
n Create check list of needs: pencil, paper, calculator, etc., for each individual child to use.
n Frame the teacher’s desk with colored tape to help student focus.
n Keep
rules few and simple.
n Be consistent in your enforcement of the rules.
n Allow access to drinking fountains and bathrooms.
n Permit movement within boundaries.
n Follow through with structure and allow for adaptations.
n Communicate rules with words and pictures when possible.
n Schedule free time.
n Set up “information center” where student can go if lost.
Using Multiple Modalities, Multi-sensory, Manipulatives
Interventions for
Elementary School
Students
n Facilitate
cooperative learning with peer tutors.
n Use music/chimes/songs to cue interactions with pictures.
n Adapt curriculum to be more multi-sensory.
n Highlight important points in text books for students.
n Increase movement opportunities to accommodate different modalities.
n Use open-book tests.
n Cut worksheets into smaller strips so the student can work on a few
problems at a time.
n Encourage the use of computers and tape recorders.
n Create listening posts with textbooks on tape.
n Accept different demonstrations that material has been learned.
n Integrate physical activity with learning.
n Encourage generalization of abilities by having experiences outside
of class.
n Use guided oral practice.
n Use hands-on manipulative activities.
n Use multi-sensory methods of presentation.
n Appeal to multiple intelligences.
n Employ use of all senses and modes of communication.
n Use role plays to model appropriate behavior, demonstrate a skill,
generalize a new concept.
n Use music to teach vocabulary and to help remember processes.
n Encourage developmentally appropriate quality of speech.
n Facilitate the understanding of the concept of numbers, not just the
memorization of numbers.
n Teach the number one first: one pencil, one ball, etc.
n Touch and count objects.
n Use money and time to teach addition and subtraction.
n Use books with simple, plain pictures.
n Read aloud to children.
n Use sensory stimulation to teach concepts; to teach the color
orange, wear orange clothes, paint with orange paint, use orange
paper.
Interventions for
Elementary School
Students
n Focus
on the process.
n Review or teach adaptation.
n Break learning into pieces.
n Preteach/reteach.
Creating Opportunities for Decision Making and Problem
Solving
n Create
a “negotiations table” where students can go to resolve
conflicts.
n Allow students to help one another.
n Provide opportunities to apply concepts in functional contexts
(instead of using a worksheet on fractions; measure and cook).
n Teach basic social skills using role plays.
n Provide structured choices.
n Foster independence in school work and in play.
n Provide choices and encourage decision making.
n Teach daily living skills.
n Encourage positive self-talk.
n Use
mentors to model and reinforce positive behaviors.
n Provide immediate feedback on responses.
n Role play, allow students to perform skits for different social/
behavioral situations.
n Take photographs of a child doing what is requested.
n Use buddy system for social situations.
n Demonstrate directions given to student.
n Teach relaxation skills.
n Talk to the student about using language appropriate for his or her
level.
Providing Structure
n Create
“work folders” containing alternatives to the traditional
lesson.
n Establish alternative “stations” where lessons can be completed.
n Provide for change within the structure.
n Allow additional time to complete assignments.
n Use visual, musical, or physical cues to signal changes, transitions.
n Create a space where students can take walks or laps.
n Leave resource rooms open before school and during recess to help
students who have problems with “free time.”
6
Interventions for
Elementary School
Students
n Create
schedules using words, pictures, clocks.
n Provide folders with the schedule for the day.
n Post calendar/schedule of daily events.
n Begin and end routines with cues.
n Open and close the day with rituals.
n Identify and discuss changes in the schedule in advance of the occurrence.
n Review the day’s schedule each morning and afternoon.
Ensuring Consistency in Scheduling
n Maintain
a consistent, predictable routine from day to day.
n Provide calendars for the week that highlight each day’s special
events (library, music).
n Teach routines and reteach; don’t make assumptions that the
student knows the routine.
n Teach child to prepare for the next day before going to bed.
Planning for Change
n Prepare
the student in advance (days, if possible) if you will be
gone.
n Ensure that substitute plans contain information about the student.
n Use manipulatives to show change/termination of activity.
n Give directions about change in small increments.
n Preteach unusual circumstances (substitutes, fire drill, assemblies,
interruptions).
n Use
music at transition times.
n Give signals leading up to transition, at 5 minutes and at 3 minutes.
n Use environmental cues (bells, dimming lights).
n Use a timer.
n Create a system of cues that can be used outside the classroom.
n Have the activity ready for the next instructions period.
n Use 4 steps: forewarn, anticipate, state, and act.
n Make sure there is closure to every lesson.
n Give cues for the ending and beginning of activities.
n Let student take breaks during the day for napping or moving around.
7
Interventions for
Elementary School
Students
8
n Establish
a pre-arranged signal with the student for you to know
when he or she is upset.
n Use signals plus words.
n Use “echo system”: call out a cue; students echo command.
n Use visual aides for landmarks or lining up.
n Establish visual cues for activities and learning centers.
n Use music/bells/songs to cue interactions, with pictures of where
the student is and where the student is going.
Interventions for Middle School Students
By the time students with FASD are teenagers, they recognize
that they are different from other students. Their social skills are
developmentally several years behind their peers, and they have
problems maintaining relationships. Strategies that allow them to fit
in without being conspicuous help to address these concerns.
n Provide
beanbag chairs and pillows.
n Provide a space where students can “ground themselves.”
n Provide portable study carrels.
n Establish a space where the student can go to have some quiet time alone.
Classroom Seating
n Assign
seating toward the front of the classroom.
n Provide carpeting, nonpedestal desks, and flat desk tops.
n Use name tags on chairs, desks, and/or floor.
Limit Distractions
n Ask
student what environment works best for him or her: groups or
individual, lights on or off, radio on or radio off.
n Limit classroom interruptions. For example, have attendance sheets
picked up outside the classroom.
n Keep bulletin boards simple.
n Encourage headsets for students who work well with them.
n Put curtains or other coverings on windows to limit outside
distractions.
Organize Materials
n Organize
materials around themes.
n Ensure materials are located in a consistent location and labeled.
n Label everything.
n Establish
consistent and clearly identified rules.
n Allow students to help establish classroom rules and post them. n State classroom rules in the positive.
n Post rules; review frequently and enforce consistently.
n Communicate rules, guidelines, and limits to parents.
OrganizingSandra
Sandra,agrade8studentwithFAE
andahigh/averageIQ,wasconsistently
latetoherfirstclasseventhoughher
motherdrovehertoschoolontime.
Theteachersandschoolcounselor
hadspokenwithSandraaboutbeing
responsibleandplacedherona
behaviormodificationprogramwhere
shereceivedpointsforbeingontime
andmadeuptimemissedinanafter
schooldetentionprogram.Sandra
becamehighlystressedandwasoften
unabletosleepatnight.
Onedaythecounselorobserved
Sandra.Shesawthestudentget
outofhermother’scar,godirectlyto
herlocker,andbegintosearchout
materialsforclass.Asthestudents
clamoredinthehallandthenoiselevel
increased,Sandrabecameincreasingly
agitatedassheattemptedtoscreenout
thedistractionsandfindherschool
supplies.Whenthebellrangand
thehallquieted,Sandrarelaxedand
wasabletofocus.Sheretrievedher
materialsandrushedtoclass–late.
Onarrival,shewassentbacktoget
homework.Aftersearchingformore
than10minutes,sheburstintotears
aloneinthehallway.
Fortunately,thecounselorwasfamiliar
withtheorganizationaldifficultiesof
studentswithinformationprocessing
deficitsandwasabletohelpSandra
organizeherlocker.Together,theyput
thesuppliesforeachclassintoseparate,
color-codedbags.NowSandrawalks
toherlockerbeforeeachclassand
pullsoutthecorrectbag.Shehasbeen
supportedandassistedtomeetherbasic
needsforcompetencyandbelonging
andisnolongerlateforclass.
Interventions for
Middle School
Students
n Permit
audio taping of lectures.
n Allow peer tutor to take notes.
n Provide computers in classroom or permit laptops from home.
n Put digital clocks in classroom.
n Use interest stations or centers to provide opportunities for cooperative learning.
n Use books on tape.
n “Level” activities according to developmental stage.
n Give student opportunities to use art to express feelings.
n Use concrete materials to teach math (measuring cup, coins).
n Permit the use of calculators for math.
n Allow accommodations in instruction and assessment (highlighting
text, tape recording text, bracketed outlining).
n Employ music and movement to express feelings.
n Recognize and accommodate various learning styles.
n Role play feelings, situations, historical events.
n Teach abstract concepts with concrete materials (calculators,
stopwatch, pattern blocks, geo boards, fraction pieces).
n Use themes to integrate activities.
n Use Gardener’s seven intelligences (linguistic, logical-mathematical,
musical, spatial, bodily-kinesthetic, intrapersonal, and interpersonal).
n Give simple instructions.
n Teach a new skill in the setting in which it will be used.
n Break
assignments down into small, simple steps.
n Use sequential teaching.
Solving
n Teach
basic social skills using role plays.
n Foster independence in school work and in play.
n Create a structured environment that includes limited choices and encourages decision making.
0
n Implement
a buddy system with selected peers.
n Educate students about personal boundaries.
n Teach social skills and anger management.
n Teach relaxation techniques.
n Provide opportunities to apply skills; use role play and games to teach transfer to other situations.
n Establish peer/buddy system for lunch, free time, in between classes.
Interventions for
Middle School
Students
Providing Structure
n Allow
additional time to complete assignments.
n Introduce day planners.
n Provide supervision.
n Schedule
academics in the morning and electives in the afternoon.
n Use a block schedule.
n Provide a daily assignment sheet.
n Group classes near each other to keep the student from having to walk long distances from one class to another.
n Be willing to modify the student’s schedule.
n Use notebooks/assignment sheets/sticky notes to help the student
organize his or her day.
n Color code subjects in notebooks for organization.
n Preview class period/week.
n Make daily progress reports.
n Extend timelines for homework and modify curriculum, if
necessary.
n Teach student to keep a daily schedule using clear and simple
reminders.
n Prepare students for different classroom expectations by putting
icons on the first page of the notebook for that class (picture of
pencil, remember to bring pencil).
Interventions for
Middle School
Students
n Provide
a consistent beginning of each class.
n Provide a consistent routine at the end of class.
n Use consistent seating in class and on the bus.
n Set consistent time to meet with student in an advisory role.
n Require the student to check in every day.
Planning for Change
n Remind
student of appropriate behavior before activity.
n Explain changes in advance.
n Practice fire drills, changing classes.
n Pre-teach; pre-correct.
n Allow
student to leave early to change classes.
n Use predetermined cues to signal transitions.
n Have relaxing music playing when student enters room.
n Give notice of upcoming transitions (5 minutes, then 4 minutes).
n Build transitions into routines.
n Display
pictures of the day’s schedule with arrows to signal
transitions and sequence.
n Use an egg timer to signal the end of an activity.
n Have student assist in developing cues.
n Give notice at 10 minutes, then 5 minutes that the activity will be
ending.
Interventions for High School Students
“One of the most debilitating effects of prenatal alcohol exposure
involves the development and use of social communication. Social
communication enables people to influence ‘day-to-day’ events in
their lives” (Coggins, Friet, & Morgan, 1997, 221).
n Provide
an opportunity for students to take time out to re-group.
n Provide a space inside and outside where students can “ground
themselves.”
n Provide portable study carrels.
n Teach relaxation techniques.
n Assign
the student seating toward the front of the classroom.
n Provide both desks and tables in each classroom.
n Use interest centers or stations to provide cooperative learning
opportunities.
n Provide space for a “safe zone.”
n Seat students so that they do not distract each other.
n If using circle seating, place the student directly across from the
teacher to help the student maintain eye contact and focus.
n Ask
students what environment works best for them: groups or
individual, lights on or off, radio on or radio off.
n Limit classroom interruptions. For example, have attendance sheets
picked up outside the classroom.
n Observe and respond to patterns of behavior. Does the student
attend better with auditory stimulation? Does the student need to
be physically active? Does visual stimulation distract the student?
n Encourage headsets for students who work well with them.
n Put curtains or other coverings on windows to limit outside
distractions.
AaronLearnsbyDoing
Aaronisingrade9andhasFAS.
Hehasbeensuspendedfromschool
15timesbetweenSeptemberand
earlyDecember.Thirteenofthe
15suspensionswereduetohis
uncooperativebehaviorduringlunch
time.Aaronhasreceivedspecial
educationassistancetomanagehis
emotionaldisturbancesonan
ongoingbasis.
Whenaspecialistfamiliarwiththe
challengesofFASaskedAarontotell
heraboutschool,hereplied,“Mr.
Williamsdoesn’tlikeme.Healways
yellsatmeinfrontofthekidsatlunch.
Ihatehim.”
ThespecialistaskedAarontorecitethe
rulesforlunchtimebehavior,which
hedidpromptlyandperfectly.Ona
hunch,shewalkedwithAarontothe
emptylunchroomandsaid,“Showme.”
Aaronwasunabletodemonstratethe
correctbehavior,evenmissingwhere
hewassupposedtosit.Thespecialist
spenttherestoftheirsessionactually
practicingtherulesandeventooksome
picturesofhimsohecouldreview
themlater.
Aaronwassuspendedtwomoretimes
duringtherestofschoolyear,neither
timeforlunchroombehavior.
n Establish
consistent and clearly identified rules.
n Allow students to help establish classroom rules and post them.
n State classroom rules in the positive.
n Post rules; review frequently and enforce consistently.
n Communicate rules, guidelines, limits to parents.
Interventions for
High School Students
n Provide
a schedule of class expectations in advance.
n Permit audio taping of lectures.
n Allow peer tutors to take notes. n Provide computers in classroom or permit laptops from home.
n Put digital clocks in classroom.
n Use interest stations or centers to provide opportunities for cooperative learning.
n Use books on tape.
n “Level” activities according to developmental stage.
n Give student opportunities to use art to express feelings.
n Use concrete materials to teach math (measuring cup, coins).
n Permit the use of calculators for math.
n Allow accommodations in instruction and assessment (highlighting
text, tape recording text, bracketed outlining).
n Provide a variety of methods to measure student’s learning such as
oral tests or graded homework.
n Adapt the modality to the student’s strengths. Allow student to
produce in his or her strength modality.
n Employ music and movement to express feelings.
n Recognize and accommodate various learning styles.
n Role play feelings, situations, historical events.
n Teach abstract concepts with concrete materials (calculators, stop
watch, pattern blocks, geo boards, fraction pieces).
n Use themes to integrate activities.
n Use art to explain a process.
n Use Gardener’s Seven Intelligences (linguistic, logical-mathematical,
musical, spatial, bodily-kinesthetic, intrapersonal, and interpersonal).
n Teach a new skill in the setting in which it will be used.
n Provide hands-on learning opportunities.
n Provide a vocational component or nonacademic assignment (office
aide).
n Break
assignments down into small, simple steps.
n Teach small pieces of knowledge at a time.
n Use mapping techniques rather than linear outlines to show structures (main idea-subsequent ideas).
n Use sequential teaching.
Interventions for
Solving
n Teach
basic social skills using role plays.
n Foster independence in school work and in extra-curricular
activities.
n Create a structured environment that includes limited choices and
encourages decision making.
n Arrange for a signal a student can give when he or she feels
comfortable in a situation and able to answer.
n Implement
a buddy system with selected peers.
n Educate students about personal boundaries.
n Teach social skills and anger management.
n Provide opportunities to apply skills; use role play and games to teach transfer to other situations.
n Remind student of appropriate behavior before activity.
n Assign a peer helper to track the student (especially during lunch)
to determine if the student can make good decisions during free or
unstructured times.
Providing Structure
n Allow
additional time to complete assignments.
n Introduce day planners.
n Create a structured environment that includes limited choices.
n Provide supervision.
n Integrate subjects to help with transitions.
n Limit the number of different instructors involved with the student.
Interventions for
n Preview
class period/week.
n Schedule most academic subjects early in the day.
n Schedule active and hands-on experiences later in the day.
n Arrange schedule so that student is assigned to classes that allow the
most freedom of movement.
n Group classes near each other to keep the student from having to
walk long distances from one class to another.
n Be willing to modify the student’s schedule.
n Use notebooks/assignment sheets/sticky notes to help the student
organize his or her day.
n Color code subjects in notebooks for organization.
n Provide daily progress reports.
n Extend timelines for homework and modify curriculum, if
necessary.
n Teach student to keep a daily schedule.
n Prepare students for different classroom expectations by putting
icons on the first page of the notebook for that class (picture of
pencil, remember to bring pencil).
n Provide
a consistent beginning for each class.
n Provide a consistent routine at the end of each class.
n Set consistent time to meet with student in an advisory role.
n Require students to check in every day.
n Establish clear and set routines.
Planning for Change
n Explain
changes in advance.
n Practice changing classes early in the year.
n Pre-teach; pre-correct.
n Allow
student to leave early to change classes.
n Use pre-determined cues to signal transitions.
n Build transitions into routines.
n Provide
cues such as hard copy of overheads, fill in the blank
information, outlines of lectures with room for notes.
n Have student assist in developing cues.
n Give notice at 10 minutes, then 5 minutes that the activity will
be ending.
6
Health Care Interventions
The education system can play an important role in assisting families
in managing the challenges of raising a child with FASD. Included in
those challenges are managing the health care implications of FASD.
School administrators, health care professionals, teachers, and families
can participate as partners for a child with FASD by ensuring
n early identification and treatment
n increased knowledge and understanding of FASD
n improved ability to manage the condition
n a supportive nurturing environment.
To achieve these goals, school administrators, health care
professionals, and teachers should work with families to
n develop a personal and family medical history
n develop a plan of care
n develop an understanding of FASD and how to manage the
condition
n create an environment that meets the needs of the child with FASD
n foster healthy coping skills for the child and the family
n foster self-esteem in the child
n plan for educational needs, including postsecondary education
n plan for career/employment needs
n plan for transition to the adult health care system.
Teachers, school health care professionals, and school administrators
will likely encounter several students with FASD during their careers.
Some of these children will have FAS and may be easy to recognize.
Many more of these children will have other effects of prenatal
alcohol exposure. These children may not be as easy to recognize.
The following is a list of diagnostic centers in Florida that will
provide additional information on diagnosis, treatment, and working
with families and their children with FASD. Additionally, section
5 contains a comprehensive list of FASD books, videos, support
organizations, newsletters, and websites.
7
Health Care
Interventions Diagnostic Centers
All Children’s Hospital
880 Sixth Street S, Suite 240
St. Petersburg, Florida 33701
(727) 892-6760; (727) 892-8491
University of South Florida Regional Genetics Program
10770 North 46th Street,
Tampa, Florida 33617-3451
(813) 975-6900 Fax (813) 975-6615
University of South Florida
Developmental Evaluation & Intervention Program
17 Davis Boulevard, Suite 200
(813) 272-2972 Fax (813) 272-2962
Nemours Children’s Clinic
85 W Columbia Street
Orlando, FL 32806
(407) 650-7245 Fax: (407) 650-7248
Tampa Children’s Hospital Child Development Center
4144 N Armenia Avenue, Suite 375
(813) 876-8316
Shands Hospital
Department of Pediatric Neurology, University of Florida
1600 SW Archer Road, Room HD403
Gainesville, Florida 32610
(352) 392-6442, Fax (352) 392-9802
Jackson Memorial Hospital
Mailman Center for Child Development
1061 NW 12th Ave.
Miami, FL 33136
(305) 243-6006
Florida Center for Family and Child Development
4620 17th St.
Sarasota, FL 34235
(941) 371-8820
www.childdevelopmentflorida.org
8
SectionFive
Resources
Books
Alcohol, Health and Research World, Special Focus:
Alcohol-Related Birth Defects. Alcohol,Healthand
ResearchWorld; Vol. 18, No. 1, 1994; to order this special
edition call (800) 553-6847. For more information on
subscribing contact the U.S. Government Printing Office at
(202) 783-3238.
The Best I Can Be: Living with Fetal Alcohol Syndrome or
Effects. Kulp, L., & Kulp, J. Order at www.betterendings.org
(763) 531-9548.
The Broken Cord. Dorris, M., 1989, 300 pgs. Story by a
father about his adopted son, Adam, who has fetal alcohol
syndrome. Cost: $18.95 hard back; $9.95 paperback. Order
from: Harper & Row, Publishers, 10 East 53rd St., New York,
NY 10022.
Bruised Before Birth: Parenting Children Exposed to
Parental Substance Abuse. Publication addresses the needs
of children through adolescence. Cost: $14.95 plus $2.75
postage and handling. Order from: Family Resources, 1521
Foxhollow Rd., Greensboro, NC 27410.
Cheers, Here’s to the Baby. LaFever, L. Story by a mother
about her son who has FAS. Order from: FAS*FRI
Publications, PO Box 2525, Lynnwood, WA 98036.
Email at: [email protected]
Children with Fetal Alcohol Syndrome: A Handbook for
Parents and Teachers. Burd, L., 1998. Helps parents and
teachers understand FAS. 1300 South Columbia Road, Grand
Forks, ND 58202. (701) 780-2477.
Fantastic Antone Grows Up: Adolescents and Adults with
Fetal Alcohol Syndrome. Kleinfeld, J. M., Wescott, S., &
Morse, B. (Eds.). Order from: NOFAS, 1819 H Street NW,
Suite 750, Washington, DC 20006. (202) 785-4585.
Fantastic Antone Succeeds: Experience in Educating
Children with FAS. Kleinfeld, J. M, Wescott, S. (Eds.) 1993,
361 pgs. Cost: $23.50 softcover, $33.50 hardcover S/H
included. Order from: NOFAS, 1819 H Street NW, Suite
750, Washington, DC 20006. (202) 785-4585.
FAS and FAE and Education: The Art of Making a
Difference. Berg, S. et al. 1997. The FAS and FAE Support
Network of British Columbia, #151-10090, 152nd Street,
Suite 187, Surrey, BC V3R 8X8. (604) 589-1854,
Fax: (604) 589-8438. Email: [email protected]
FAS/FAE: A Practical Guide for Parents. 1994. Slinn,
J. Based on experiences with his two FAS adopted
children. Order from: Parents Resource Network, 540 West
International Airport Road, Anchorage, AK 99518-1110,
(907) 564-7489.
FAS: Parent and Child: A Handbook. Morse, B. A., &
Weiner, L., 1992. Fetal Alcohol Education Program, Boston
University School of Medicine, 1975 Main Street, Concord,
MA 01742. (978) 369-7713.
Fetal Alcohol Syndrome/Fetal Alcohol Effects Strategies
for Professionals. Malbin, D., 1993. Hazelden Educational
Materials, Pleasant Valley Road, P.O. Box 176, Center City,
MN, 55012-0176. (800) 328-9000.
Fetal Alcohol Syndrome: A Guide for Families and
Communities. Streissguth, Ann, Ph.D., 1997. Paul H.
Brookes Publishing Company, P.O. Box 10624, Baltimore,
MD 21285-0624. www.brookespublishing.com/store/books/
streissguth-2835/index.htm
Fetal Alcohol Syndrome: The Impact on Children’s Ability
to Learn. National Health/Education Consortium Occasional
Paper #10. Institute for Educational Leadership, 1001
Connecticut Ave. NW, #310, Washington, DC 20036.
(202) 872-8450.
Handle with Care: Helping Children Prenatally Exposed
to Drugs and Alcohol. Villarreal, S. F., Mckinney, L. E.,
Quackenbush, M., 1992, 200 pgs. Cost $17.95, soft cover.
Order from: Sales Department, ETR Associates, P.O. Box
1830, Santa Cruz, CA 95061-1830. (800) 321-4407.
Layman’s Guide to Fetal Alcohol Syndrome and Fetal
Alcohol Effects. Berg, S., et al., 1995. Cost $15.00. (604)
589-1854, Fax: (604) 589-8438. Email: [email protected]
My Name Is Amanda and I Have FAE — A Book for Young
Children with FAS/E Published by: FAS/E Support Network
of B.C., Cost: $8.50. (604) 589-1854. Email: [email protected]
Our FAScination Journey: The Best We Can Be, Keys to
Brain Potential Along the Path of Prenatal Brain Injury.
Kulp, J. (763) 531-9548. Order from: www.betterendings.
org.
Reaching Out to Children with FAS and FAE. Davis, D.,
1992. Handbook for parents, teachers, and others who live
and work with children who have FAS/FAE. Order from: The
Center for Applied Research in Education, West Nycak, NY
10995. Published in Seattle, WA.
Recognizing and Managing Children with Fetal Alcohol
Syndrome/Fetal Alcohol Effects: A Guidebook. McCreight,
B. Cost $16.50. Order from: CWLA, c/o CSSC, 130
Campus Drive, Edison, NJ 08818-7816, when ordering ask
for stock # 607-0. (800) 407-6273. www.cwla.org
So Your Child Has FAS and FAE – What You Need to
Know. Berg, S., et al., 1997. The FAS and FAE Support
Network of British Columbia, #151-10090, 152nd Street,
Suite 187, Surrey, BC V3R 8X8. (604) 589-1854,
Fax : (604) 589-8438. Email: [email protected]
Trying Differently Not Harder. Malbin, D. Sequel to
Fetal Alcohol Syndrome/Fetal Alcohol Effects Strategies for
Professionals. Available only at Fascets Marketplace,
(503) 621-1271.
Videos
Alcohol and Pregnancy: Fetal Alcohol Syndrome and Fetal
Alcohol Effects. A video showing how alcohol adversely
affects the developing fetus and pointing out critical periods
during pregnancy when the fetus is most vulnerable. Through
candid interviews, it presents a realistic look at the daily
struggles of the FAS/FAE child and his parents or caregivers.
20 minutes. Cost $295. To order, write: Aims Media,
9710 DeSoto Avenue, Chatsworth, CA 91311-4409.
(800) 367-2467. Contact for free previews and rentals.
The Clinical Diagnosis of Fetal Alcohol Syndrome. A new video by Jon M. Aase, M.D., shows complete and never before seen information on the clinical diagnosis of FAS. The video can be purchased for the price of $150.00 + $9.00 for S/H from Flora & Company P.O. Box 8263 Albuquerque, NM 87198-8263, or by calling (505) 255-9988, 24 hours a day.
FAS. Includes interviews with noted experts Sterling Clarren, M.D., Diane Malbin, M.S.W., Antonio Rathbum, and others. 45 minutes. Cost $225, plus $6.00 for shipping and handling. Order from: Hazelden Educational Materials, Box 176, Center City, MN 55012.
Fetal Alcohol Syndrome and Effect: Stories of Hope
and Help. Families and individuals affected by fetal alcohol
exposure share their stories. Cost $225. Order from:
Hazelden, P.O. Box 176, Pleasant Valley Road, Center City,
MN 55012. (800) 329-9000.
Four Part Series on FAS. Provides information for caregivers about how to handle children with FAS as they get older. Cost: $345/tape. To order, write: Altschul Group Corporation, 1560 Sherman Ave., Suite 100, Evanston, IL 60201-9971. (800) 421-2363. Contact regarding free previews and rentals.
Training Tapes for Living with F.A.S. and F.A.E. TheEarly
Years,TheSchoolYears, and AFocusonPrevention explaining the cause of FAS and FAE and how to care for and better meet the needs of children with FAS/FAE. Each tape is 20 minutes long and costs $295. To order, write: Altschul Group Corporation, 1560 Sherman Avenue, Suite 100, Evanston, IL 60201-9971. (800) 421-2363. Contact regarding free previews and rentals.
Training Tapes of Living with F.A.S. and F.A.E. TheEarly
Years,BirththroughAge12, and Independence,Ages12toAdult
seek to assist those living with FAS/FAE and their families from soothing a fussy baby to adaptive living skills. Each tape is 32 minutes long and costs $295. To order, write: Altschul Group Corporation, 1560 Sherman Avenue, Suite 100, Evanston, IL 60201-9971.
Worth the Trip: Raising and Teaching Children with Fetal
Alcohol Syndrome. About health, development, and learning
style of a child with FAS. Cost $150. Order from: Vida Health
Communications, 6 Bigelow Street, Cambridge, MA 02139.
Phone: (617) 864-4334, Fax: (617) 864-7862.
0
Support Groups, Agencies,
and Organizations
Adoptive & Foster Moms Support Group (AM/FM)
Beaver Dam, WI
Sandy Yaroch
Email: [email protected]
(414) 885-6903
Adult Children of Alcoholics
P.O. Box 3216
Torrance, CA 90510
(310) 534-1815
Alcoholics Anonymous
P.O. Box 459, Grand Central Station
New York, NY 10163
(212) 870-3400
www.alcoholics-anonymous.org/econtent.html
Al-Anon
Al-Anon Family Group Headquarters
1600 Corporate Landing Parkway
Virginia Beach, VA 23454-5617
(888) 4AL-ANON / (757) 563-1600
Fax: (757) 563-1655
www.al-anon.alateen.org
American Medical Association
515 N. State St.
Chicago, IL 60610
(312) 464-5000
The Arc (a national organization on mental retardation)
500 East Border Street, Suite 300
Arlington, TX 76010
(800) 433-5255
The Association for Retarded Citizens of Florida
2898 Mahan Drive, Suite #1
Tallahassee, FL 32308
(850) 921-0460
Centers for Disease Control and Prevention
Division of Birth Defects and FAS Prevention Section
4770 Buford Hwy. NE (MS F15)
Atlanta, GA 30341-3724
(404) 488-7370
Center for Science in the Public Interest
Alcohol Policies Project
1875 Connecticut Ave. NW, #300
Washington, DC 20009
(202) 332-9110
Children of Alcoholics Foundation
555 Madison Avenue, 20th Floor
New York, NY 10022
(212) 754-0656 / (800) 359-2623
Child Development Unit, Kids in Need Program
University of Colorado Health Sciences Center
Child Development Unit, B-140
The Children’s Hospital
1056 East 19th Ave
Denver, CO 80218
(303) 861-6630
Families Anonymous (FA)
P.O. Box 3475
Culver City, CA 90231
Phone: (800) 736-9805
Family Empowerment Network Support Group,
(The FEN Pen Newsletter)
Georgiana Wilton
610 Langdon St., 519 Lowell Hall
Madison, WI 53703
(800) 462-5254
Fetal Alcohol Task Force
1016 East First Street Port
Angeles, WA 98362
Fetal Alcohol Education Program
Boston University School of Medicine
1975 Maine St.
Concord, MA 01742
(978) 369-7713
Fetal Alcohol and Drug Unit
University of Washington
180 Nickerson St., Suite 109
(206) 543-7155
FAS Family Resource Institute
P.O. Box 2525
Lynwood, WA 98036
(206) 778-4048
FASWorkshops;AdultandTeenPreventionPrograms
Fetal Alcohol Syndrome Support Network (FASN)
Margaret Sprenger Mississauga Coordinator
2266 Homelands Drive
Mississauga, ON L5K1G6
Phone/Fax: (905) 822-0733
Florida Alcohol and Drug Abuse Association
Association Resource Center
(850) 878-2196
www.fadaa.org
Florida Department of Children and Families
1317 Winewood Blvd. Building 1, Room 202
Tallahassee, Florida 32399-0700
Phone: (850) 487-1111 / Fax: (850) 922-2993 Florida Department of Health
4025 Esplanade Way
Tallahassee, Florida 32399-1723
Phone: (850) 245-4444
International F.A.S. Trainer
Contact Keith Wymer,
P.O. Box 312
Angel Fire, NM 87710
Email: [email protected]
March of Dimes Birth Defects Foundation
1275 Mamaroneck Ave.
White Plains, NY 10605
(914) 428-7100
National Association for Perinatal Addiction Research and
Education (NAPARE)
200 N. Michigan Ave., #300
Chicago, IL 60601 (312) 541-1272 / (800) 638-BABY
National Clearinghouse for Alcohol and Drug Abuse
Information (NCADI)
P.O. Box 2345
Rockville, MD 20847-2345
(800) 729-6686
National Council on Alcoholism and Drug Dependence
(NCADD)
12 West 21 St.
New York, NY 10010
(212) 206-6770
National Institute on Alcohol Abuse and Alcoholism
(NIAAA)
Wilco Bldg. 600 Executive Blvd.
Rockville, MD 20852
(301) 443-6370
National Indian Health Service Fetal Alcohol Syndrome
Project
Headquarters West
5300 Homestead Rd. NE
Alburquerque, NM 87110
(505) 837-4228
National Organization on Fetal Alcohol Syndrome
(NOFAS)
1815 H St., NW, Suite 1000
(202) 785-4585 / 800) 66-NOFAS (666-6327)
National Perinatal Information Center
One State Street, Suite 102
Providence, RI 02908
National Association for Native American Children of
Alcoholics
1402 3rd Ave., Suite 1110
Seattle, WA 98101
(206) 467-7686 / (800) 322-5601
National Black Alcoholism Council
285 Genesee St.
Utica, NY
(315) 798-8066
National Coalition for Hispanic Health and Human
Services
1501 16th St. NW
(202) 387-5000
National Council on Disability
1331 F St., NW, Suite 1050
Washington, DC 20004-1107
(202) 272-2004
National Women’s Resource Center for the Prevention and
Treatment of Alcohol, Tobacco and other Drug Abuse and
Mental Illness
200 N. Michigan Ave, Suite 300
Chicago, IL 60601
(800) 354-8824 / (312) 541-1272
National Women’s Health Network
1325 G St. N,
(202) 347-1140
Parent to Parent
(800) 527-9552
Organizationservingasasupportnetworkforparentsofchildren
withdisabilitiesinFlorida.
Resource Center on Substance Abuse Prevention and
Disability
1331 F St. NW, Suite 800
(202) 783-2900
SAMHSA National Clearinghouse for Alcohol & Drug
Abuse Information
(800) 729-6686 Providesinformationpackets,brochures,literaturesearches.
SNAP (Society of Special Needs Adoptive Parents)
409 Granville Street, Suite 1150
Vancouver, BC V6C1T2, Canada
(604) 687-3114
Support Group for Adoptive and Foster Parents
Contact: Ronnie Jacobs
Paramus, NJ
(201) 261-1450
Toughlove
P.O. Box 1069
Doylestown, PA 18901
Phone: (215) 348-7090 / Fax: (215) 348-9874
Women for Sobriety
PO Box 618
Quakertown, PA 18951-0618
(800) 333-1606 Newsletters
Iceberg Newsletter
P.O. Box 95597
Seattle, WA 98145
Manitoba FAS News
CAP, Manitoba Medical Assn.
125 Sherbrook St.
Winnipeg, Manitoba, Canada R3c2B5, Attn: D. Ridd \ (204) 944-6360
F.A.S. Track
PO Box 3418
Peoria, IL 61612
(309) 691-3800
FANN – Fetal Alcohol Network Newsletter
158 Rosemont Avenue
Coatsville, PA 19320
Listing of National Support Groups \ (610) 384-1133
F.A.S. Times
The Family Resource Institute
PO Box 2525
Lynnwood, WA 98036
(206) 531-2878 / (800) 999-3429
Subscriptions available: $15.00(family), $25.00 (Professional)
The Clearinghouse for Drug Exposed Children Newsletter
Division of Behavioral and Developmental Pediatrics University of California, San Francisco 1350 7th Avenue, Room 101 San Francisco, CA 4143-1311
(415) 476-9691
Growing With FAS/FAE Newsletter
7802 SE Taylor
Portland, OR 97215
Contact Pamela Groves / (503) 254-8129
FAS/FAE Newsletter
c/o Mailbag
P.O. Box 74612
Fairbanks, AK 99707
Support group, contact Gail Hales (907) 456-2866
Notes from NOFAS
1819 H St, NW, Suite 750
Washington DC 20006
(800) 66-NOFAS
The FEN Pen / Family Empowerment Network
University of Wisconsin-Madison
777 S. Mills St. Madison, WI 53715
(608) 262-6590 / (800) 462-5254
Subscriptions available: $5.00 (Family), $10.00 (Professional)
SNAP (Society of Special Needs Adoptive Parents)
409 Granville Street, Suite 1150
Vancouver, BC V6C1T2, CANADA
(604) 687-3114
Subscription available: $15.00 (Individual Membership), $20.00 (Family), $35.00 (Group/Society)
Other Resources
Alcohol Research and Health has an ARBD Update, Vol.
23(3), 2001, entire volume is FAS related $20/year. Back
issues are sometimes available. Write to Superintendent of
Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954.
Call (202) 512-2250 processing code is #5746.
Alcohol, Pregnancy, and the Fetal Alcohol Syndrome. This
new slide-lecture unit from Project Cork of the Dartmouth
Medical School contains seventy-nine full color slides, with
accompanying text, covering the effects of maternal drinking
on fetal development. The slide unit is available from MilnerFenwick, Inc., 2125 Greenspring Drive, Timonium, MD
21093. To order call (800) 432-8433 or fax (410) 252-6316.
CSAP National Clearinghouse for Alcohol & Drug Abuse
Information. Provides referrals, information packets according
to need or topics of interest, and literature search service, or
select from their 1,000 publications. (800) 729-6686.
CSAP National Resource Center for the Prevention
of Perinatal Abuse of Alcohol and Other Drugs. For
health professionals and educators interested in obtaining
information. 9302 Lee Highway, Fairfax, VA 22301. (800)
354-8824.
Drug and Alcohol 24 Hour Hotline. (800) 562-1240.
Family Health Line. Provides education about the effects of
drinking during pregnancy and helps link pregnant women
with treatment services. (800) 451-2229.
FAS Information Packet. South Dakota UAP
Interdisciplinary Center for Disabilities, Early Childhood
Research Program. 414 E Clark Street, Vermillion, SD 57069
2390 (800) 658-3080 or (605) 677-5311 ($3.00 for out-of
state).
FASERS of Florida – Fetal Alcohol Syndrome Education
Service. Email: [email protected]
FDA Drug Bulletin: Surgeon General’s Advisory on
Alcohol and Pregnancy. Information of importance to
physicians and other health professionals. Vol. 11(2), July,
1981.
Guidelines of Care for Children with Special Health Care
Needs: Fetal Alcohol Syndrome and Fetal Alcohol Effects.
Minnesota Department of Health 1999 Minnesota Children
with Special Health Needs, 85 East Seventh Place, P.O. Box
64882, St. Paul, MN 55164-0882. (651) 215-8956 (voice or
TDD) (800) 728-5420 (voice or TDD)
Hazelden Hotline. A service of the Hazelden treatment
program, helps people to overcome fears about talking to
friends and relatives with addiction problems. Call (800) I
DO-CARE.
A Manual on Adolescents and Adults with FAS with Special
Reference to American Indians. Indian Health Service FAS
Project, 5300 Homestead Avenue NE, Albuquerque, NM
87109, (505) 837-4228 (free of charge).
Men Have Babies Too. Brochure developed by the March of Dimes examines the male’s influence on the unborn baby. To order, call the March of Dimes National Office (914) 428
7100.
Office of Minority Health Resource Center. Conducts customized database searches, accessing information on health programs and organizations, as well as funding sources and articles. A printout will be mailed to you at no charge. (800) 444-6472.
Preventing FAS and Other Alcohol-Related Birth Defects: Teacher and Student Manuals. The Arc National Headquarters, 500 East Border, Suite 300, Arlington, TX 76010. (817) 261-6003.
Prevention of Perinatal Substance Use: Pregnant and
Postpartum Women and Their Infants Demonstration.
350 pages, 1993. Available free of cost. NMCHC inv. Code
G031. Order from: National Maternal and Child Health
Clearinghouse, 8201 Greensboro Drive, Suite 600, McLean,
VA 22102. (703) 821-8955, ext: 254 or 265.
Training of Trainers Manual on FAS. American Indian
Family Healing Center, 1815 39th Avenue Oakland, CA
94601. (510) 534-2737 ($20.00).
When the Bough Breaks: Pregnancy and the Legacy of
Addiction. New Sage Press, 825 NE 20th Avenue #150,
Portland, OR 97232. (503) 232-6794.
Working with FAS Children: A Handbook for Caregivers
of FAS/FAE Children. Jean Cornish, Minnesota Services
Associates. (612) 645-0688.
Websites
Alcohol Exposure During Pregnancy. Links to Learning
Disabilities, ADD and Behavior Disorders. Contains
articles written by a graduate research team at the University of
South Florida. These articles describe various environmental
and chemical factors that can adversely affect a fetus.
www.chem-tox.com/pregnancy/alcohol.htm
AlcoholismHelp.com A resource for people affected by
alcoholism. www.alcoholismhelp.com
The Arc. The national organization of and for people with
mental retardation and related developmental disabilities and
their families. (800) 433-5255.
www.thearc.org/fetalalcohol.html
ARCH — National Respite Network and Resource Center.
Access to Respite Care and Help (ARCH) helps families find
respite care options for disabled children and adults in all 50
states. Call (800) 773-5433 or go online.
www.respitelocator.org
Canadian Center on Substance Abuse. Fetal Alcohol
Spectrum Disorder Information Service. Includes an
overview of FASD, recommended readings, and resources for
professionals working with individuals with FASD and their
families. www.ccsa.ca/index.asp?ID=17
Center for Disease Control and Prevention. Posters,
information on incidence of alcohol-related birth defects and
information about funded activities related to prenatal alcohol
use. www.cdc.gov/ncbddd/fas/
Children’s Research Triangle. Ordering information for
Dr. Chasnoff ’s articles and educational tools, including
information on identifying and intervening with children with
FAS. The site also includes information to use when adopting
a child overseas. www.childstudy.org/
Facts about Alcohol Use During Pregnancy.
http://TheArc.org/faqs/fas.html
Family Village. A global community for people with varying
disabilities. www.familyvillage.wisc.edu
FAS Bookshelf. Order videos and books for families living
with FAS. www.fasbookshelf.com/buyit.html
FAS Community Resource Center.
http://come-over.to/FASCRC
FAS Facial Photographic Analysis Software.
www.depts.washington.edu/fasdpn/software.html
FAS/E Support Network of British Columbia.
www.fetalalcohol.com
FASCETS — Fetal Alcohol Syndrome Consultation,
Education, and Training Services, Inc. www.fascets.org
FASD — The Partnership to Prevent Fetal Alcohol Spectrum Disorder. Unites communities nationwide in a public health response to prevent FAS and alcohol-related birth defects. The Partnership aims to empower mothers to deliver healthy babies by encouraging women who are planning a pregnancy or already pregnant to avoid alcohol. www.prevention.samhsa.gov/faspartners FASlink. Fetal Alcohol Syndrome Information, Support & Communication Link. Includes information for families and health care professionals. www.acbr.com/fas/ fasWorld. An international alliance of parents and professional working together to prevent FAS.
www.fasworld.com National Institute on Alcohol Abuse and Alcoholism.
Includes several FAS guides for health care providers. www.
niaaa.nih.gov/publications/publications.htm
National Institutes of Health, National Institute on
Alcohol Abuse and Alcoholism. www.niaaa.nih.gov/
National Organization on Fetal Alcohol Syndrome.
Information about preventing, identifying and living with
FAS. www.nofas.org/
NIDA — National Institute on Drug Abuse.
www.nida.nih.gov/NIDAHome.html
NOFAS — The National Organization on Fetal Alcohol
Syndrome. www.nofas.org/
Northeast Consultation and Training Center. Provides
training and consultation on FAS issues.
www.taconic.net/seminars
Online Clinic. This is Dr. Larry Burd’s site. Includes a
presentation on FAS and three tools to help you estimate the
scope of the problem due to FAS and related developmental
disorders resulting from prenatal alcohol exposure in your
community.
www.online-clinic.com/#
Post Adoptive Resources Project. Support for families who
have adopted children with emotional/behavioral disabilities.
Many of the disabilities are alcohol/drug related.
www.geocities.com/heartland/prairie/4786
Region 3 FAS Partnership. Creative FAS website for parents.
www.fas-region3.com/Daily.html
SAMHSA Fetal Alcohol Spectrum Disorders Center for
Excellence. Provides information and resources about FASD.
www.fascenter.samhsa.gov
SAMHSA National Clearinghouse for Alcohol & Drug
Abuse Information. Provides information packets, brochures,
literature searches. Includes a treatment locator.
www.samhsa.gov/public/public.html
Screening for Mental Health Includes information on
screening for alcohol abuse. www.mentalhealthscreening.org/
Fetal Alcohol Syndrome/Effects. Created by Kathryn Shea, C.S.W. Rich source of information and inspiration for families of children with FAS. www.taconic.net/seminars/fas01.html
Screening for Substance Abuse During Pregnancy:
Improving Care, Improving Health. Online copy of
publication includes copies of recommended screening forms.
www.ncemch.org/pubs/PDFs/SubAbuse.pdf
Florida Alcohol and Drug Abuse Association Resource Center. Disseminates information about alcohol and other drugs to Floridians. www.fadaa.org Texas Fetal Alcohol Syndrome Consortium. Includes
information about Texas’s FAS prevention and education
initiatives as well as links to other FAS sites.
www.main.org/texasfasc
Healthy Families Florida. Promoting positive parent child relationships. www.healthyfamiliesfla.org/ HRSA (U.S. Dept. of Health & Human Services) Information Center. Downloadable manual — Screening for Substance Abuse During Pregnancy: Improving Care, Improving Health. www.ask.hrsa.gov/detail.cfm?id=MCHN092 Journal of FAS International. www.motherisk.org/JFAS U.S. Department of Health and Human Services, and
SAMHSA’s National Clearinghouse for Alcohol and Drug
Information. www.health.org
Writeslaw. Article entitled “Play Hearts, Not Poker,” about
working with and having an IEP written for special needs
children.
www.wrightslaw.com/advoc/articles/iep.bollero.hearts.htm
Motherisk. Research findings related to the effects of alcohol on pregnancy. www.motherisk.org/alcohol/index.php3 References
Mattson, S., Goodman, A., Caine, C, Delis, D., & Riley, E.
(1999). Executive functioning in children with heavy prenatal
alcohol exposure. Alcoholism:ClinicalandExperimentalResearch
23, 1808-1815.
Abel, E. (1988). Fetal alcohol syndrome in families.
NeurotoxicologyandTeratology,10,12.
Olson, H., Morse, B., & Huffine, C. (1998). Development and
psychopathology: Fetal alcohol syndrome and related conditions.
SeminarsinClinicalNeuropsychiatry,3(4), 262-84.
Clarren, S. (1986). Neuropathology in fetal alcohol syndrome.
In J.R. West (Ed.), AlcoholandBrainDevelopment(pp.158-166).
New York: Oxford University Press.
Coggins, T., Friet, T., & Morgan, T. (1997). Analyzing narrative
productions in older school-age children and adolescents
with fetal alcohol syndrome: An experimental tool for clinical
applications. ClinicalLinguisticsandPhonetics,12, 221-236.
Conry, J. (1996). Teachingstudentswithfetalalcoholsyndrome/
effects:Aresourceguideforteachers.Victoria, British Columbia,
Canada: Ministry of Education, Skills and Training,.
Davis, A., & Lipson, A. (1984). Challenge in managing a family
with fetal alcohol syndrome. ClinicalPediatrics,23, 304.
Dubovsky, D. (2002). BehavioralHealthCareEducation.
Philadelphia, PA: MCP Hahnemann University.
Finlay, G., & Sorenson, A. (1995). Whateducatorsneedtoknow
abouthavingstudentswithFetalAlcoholSyndromeandFetal
AlcoholEffectsintheclassroom:Issues,identification,intervention&
instructionalstrategies. Charlottesville, VA: University of Virginia,
The Curry School of Education. (ERIC Document Reproduction
Service No. EC304072)
Harwood, M., & Kleinfeld, J. (2002). Up front, in hope:
The value of early intervention for children with fetal alcohol
syndrome. YoungChildren, 57(4) 86-90.
Jones, K., Smith, D., Ulleland, C., & Streissguth, A. (1973).
Pattern of malformations in offspring of chronic alcoholic
mothers. Lancet,1, 1267-71.
Kleinfeld, J., & Wescott, S. (Eds.). (1993). FantasticAntone
succeeds!Experiencesineducatingchildrenwithfetalalcohol
syndrome. Fairbanks, AK: University of Alaska Press.
Malbin, D. (1993). Fetalalcoholsyndrome,fetalalcohol
effects:Strategiesforprofessionals. Center City, MN: Hazelden
Educational Materials.
Malbin, D. (2002). Fetalalcoholspectrumdisorders:Trying
differentlyratherthanharder.Portland, OR: Tectric.
Malbin, D. (2004, Spring). Fetal alcohol spectrum disorder
and the role of family court judges in improving outcomes for
children and families. JuvenileandFamilyCourtJournal, 53-64.
Mattson, S., Jernigan, T., & Riley, E. (1994). MRI and prenatal
alcohol exposure. AlcoholHealth&ResearchWorld,18(1), 49-52.
Mattson, S., & Riley, E. (1995). Prenatal exposure to alcohol:
What images reveal. AlcoholHealth&ResearchWorld,19(4), 273
277.
Mattson, S., Riley, E., Gramling, L., Delis, D., & Jones, K.
(1997). Heavy prenatal alcohol exposure with or without physical
features of fetal alcohol syndrome leads to IQ deficits. Journalof
Pediatrics,131(5), 718-721.
Mattson, S., Riley, E., Gramling, L., Delis, D., & Jones, K.
(1998). Neuropsychological comparison of alcohol-exposed
children with or without physical features of fetal alcohol
syndrome. Neuropsychology, 12(1), 146-153.
Osborne, Jan (1994). Asourcebookofsuccessfulschool-based
strategiesforfetalalcoholanddrug-affectedstudents. Portland,
OR: Western Regional Center for Drug-free Schools and
Communities.
Riley, E., Mattson, S., Sowell, E., Jernigan, T., Sobel, D., &
Jones, K. (1995). Abnormalities of the corpus callosum in
children prenatally exposed to alcohol. Alcoholism:Clinicaland
ExperimentalResearch,19(5), 1198-1202.
Sampson, P., Streissguth, A., Bookstein, F., Little, R., Clarren,
S., Dehaene, P., Hanson, J., & Graham, J. (1997). Incidence
of fetal alcohol syndrome and prevalence of alcohol-related
neurodevelopmental disorder. Teratology,56(5), 317-326.
Schenck, R., Cole, J. T., & Medina, C. (1994). Fetal alcohol
syndrome, fetal alcohol effects: Implications for rural classrooms.
ProceedingsoftheAnnualNationalConferenceoftheAmerican
CouncilonRuralSpecialEducation.
Schwab, D. (1999). Reframing perceptions: How children with
FAS/E sense the world. In L. Mayer (Ed.), Livingandworking
withfetalalcoholsyndrome/effects(pp. 79-106). Winnipeg, MB:
Interagency FAS/E Program.
Stratton, K., Howe, C., & Battaglia, F. (Eds.). (1996). Fetal
alcoholsyndromediagnosis,preventionandtreatment. Washington,
DC: National Academy Press.
Streissguth, A., & O’Malley, K. (2000). Neuropsychiatric
implications and long-term consequences of fetal alcohol
spectrum disorders. SeminarsinClinicalNeuropsychiatry,5(3),
177-90.
Streissguth, A. (1997). Fetalalcoholsyndrome:Aguideforfamilies
andcommunities.Baltimore, MD: Paul H. Brookes.
Streissguth, A., Aase, J., Clarren, S., Randels, S., LaDue, R.
Smith, D. (1991). Fetal alcohol syndrome in adolescents and
adults. JAMA,265, 1961-1967.
Streissguth, A., Barr, H., Kogan, J., & Brookstein, F. (1996).
Understandingtheoccurrenceofsecondarydisabilitiesinclientswith
fetalalcoholsyndrome(FAS)andfetalalcoholeffects(FAE). Seattle,
WA: Washington Publications Services.
Streissguth, A., & Little, R. (1994). Alcohol,pregnancy,andthe
fetalalcoholsyndrome:Unit5.Biomedicaleducation:Alcoholuse
anditsmedicalconsequences(slide lecture series, 2nd ed.) Hanover,
NH: Dartmouth Medical School Project Cork.
U.S. Department of Health and Human Services. (2000). The
tenthspecialreporttotheU.S.Congressonalcoholandhealth.
Rockville, MD: Author.
Weiner, L., & Morse, B. (1994). Intervention and the child with
FAS. AlcoholHealthandResearchWorld,18(1), 67-72.
Wilkemeyer, M., Menkari, C., Spong, C., & Charness, M.
(2002). Peptide antagonists of ethanol inhibition of L1
– mediated cell-cell adhesion. TheJournalofPharmacologyand
ExperimentalTherapeutics,303(1), 110- 116.
Florida Department of Education
John L. Winn, Commissioner
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Document 6449542

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